Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
For a patient with osteopenia or osteoporosis, how long can intravenous zoledronic acid be maintained if there are not adverse events?
I generally prescribe Zoledronate annually for three years for patients with osteoporosis who are at increased fracture risk. I will occasionally add an additional treatment 18-24 months after the third infusion if there has been a positive response to the original treatment regimen and I feel that ...
Can subclinical hypothyroidism cause myxedema coma?
While the patient's signs and symptoms mimic myxedema coma, he does not have, by definition, "myxedema" (severe hypothyroidism). The patient's normal FT4 can't be explained by his taking his levothyroxine that morning, given the 7-day half-life of levothyroxine. If he hadn't been taking his medicati...
Would atypical fractures of the hip in a parent (treated with bisphosphonate) be considered when calculating the FRAX score for a patient with osteopenia?
There is no data regarding this question so my response is only my opinion. I would not include a parental hip fracture secondary to bisphosphonate use in the FRAX prediction model since such fractures are not (by definition), typical hip fractures (femoral neck or intertrochanteric regions). Howeve...
Would you order a DEXA scan for a cervical cancer patient with osteoporosis?
This is a great question and one that we should all be contemplating. I do order Dexa scans on all of my post-menopausal patients if they have not had a current baseline. Many of them have lifestyle issues that could also have decreased bone density such as low weight, tobacco and alcohol use, etc. ...
What is the differential for elevated T3 (with suppressed T4 and normal TSH) in a patient not taking any thyroid hormones?
This patient has a low to low normal TSH, with weight loss and fatigue so I would approach this as mild hyperthyroidism, or T3 thyrotoxicosis. Sertraline has been associated with abnormal TFTs, usually an elevated TSH and low T4, not with increased T3 levels. Assess the patient for any other sympto...
Do you treat hypercalciuria in post menopausal osteoporosis with normal serum calcium and PTH?
I ABSOLUTELY recommend treating! This is the sine qua non of secondary osteoporosis with the osteoporosis being a direct consequence of the underlying hypercalciuria. Thiazides are great in this setting. I use chlorthalidone in preference to HCTZ because it has a longer half-life and can be used onc...
What is the best treatment of isolated elevated DHEA-S in a woman with clinical androgen excess (without PCOS, neoplasm, etc)?
It is important to rule out hyperprolactinemia as one of the causes of elevated DHEAS levels. We diagnosed a patient with macroprolactinoma who was referred to us for DHEAS elevation. In my experience, most such patients have either an atypical PCOS or some enzymatic abnormality in their adrenal ste...
Is there an indication for adrenalectomy in patients with subclinical Cushing syndrome and adrenal nodule?
The short answer is "Yes". The indications for surgery depend on a number of factors, including the number of comorbidities and their severity and the degree of the HPA axis abnormality (1 mg DST and baseline ACTH/DHEAS level). We tend to be more aggressive with surgery in younger patients, although...
What further work-up (if any) should be considered in patients with pituitary microadenoma and stigmata of Cushing's disease but low ACTH and repeatedly normal plasma, urinary, and salivary cortisol levels?
I would obtain history of alcohol intake, depression and anxiety, and will assess the pituitary adrenal axis by overnight dexamethasone suppression test.
Is it possible to have undetectable cortisol levels in secondary adrenal insufficiency?
Yes, you can certainly have undetectable cortisol in central AI. Low IGF-1 and low-normal FT4 would suggest hypopituitarism. Do you have a testosterone level? I would perform a GH stimulation test. An abnormal test would confirm pituitary pathology. Before this, however, I would carefully investigat...